Calcium Metabolism and the Menopause
A. S. Curry, J. V. Hewitt in Biochemistry of Women: Clinical Concepts, 1974
It is not clear at the present time whether all postmenopausal women should be given substitution therapy, or whether is should be confined to selected cases and if so which and for how long. If our preliminary data on the relation between the vaginal smear and the predisposition to fracture (Table 2) are confirmed in larger series, it could be argued that a prima facie case exists for substitution therapy in all patients with vaginal atrophy (i.e., vaginal smear with no estrogenic activity). This could imply administration of estrogens to about 25 to 50% of all postmenopausal women. The dose we favor would be in the range 25 to 50 μg of ethinyl estradiol or its equivalent in other estrogens, given cyclically for 3 weeks out of every 4 (to all but hysterectomized cases) to allow shedding of the endometrium. (In our experience, most postmenopausal women do not in fact experience regular withdrawal bleeding on this regime.) An alternative regime, recommended by Ferin and Thomas,79 is to give a 5-day course of a progestogen every 4 to 6 weeks during continuous estrogen therapy. If for any reasons, such as a history of thromboembolic disease, estrogens are contraindicated, a progestogen may be equally effective, but this is speculative at present. It could be argued that postmenopausal women should also have a calcium supplement, possibly in the form of a late night milk drink.
Paper 2
Aalia Khan, Ramsey Jabbour, Almas Rehman in nMRCGP Applied Knowledge Test Study Guide, 2021
According to April 2005 WHO Selected Practice Recommendations for Contraceptive Use, which of the following state ments regarding missed pills is false? If a woman misses three or more 30–35mcg ethinylestradiol pills in week 3 (days 15–21) of the pill packet, she should omit the pill-free interval; i.e. a new pack should be started without the 7-day break.Barrier methods or abstinence should be used for 7 days if three or more 30–35mcg ethinylestradiol pills are missed.Two pills can be taken on the same day, or even at the same time, depending on when the woman remembers.The woman requires emergency contraception if she has missed one or two 30–35mcg ethinylestradiol pills at any time.The most recent missed pill should be taken as soon as the woman remembers.
Endocrine Therapies
David E. Thurston, Ilona Pysz in Chemistry and Pharmacology of Anticancer Drugs, 2021
Diethylstilbestrol (DES) and ethinylestradiol are the main estrogenic agents in use for prostate cancer, and are described in detail below. However, it should be noted that they are not first-line treatments, and tend to be used in a palliative care setting when all other treatment strategies have failed. Both agents are associated with problematic side effects in men which are common and dose-related (e.g., venous and arterial thrombosis, nausea, fluid retention, feminization, impotency, and gynecomastia). In the past diethylstilbestrol has also been used to treat breast cancer in postmenopausal women but withdrawal bleeding, hypercalcemia and bone pain side effects can occur, and it is rarely used now for this purpose given the many more targeted therapies available. Ethinylestradiol is the most potent estrogenic agent available. Unlike other estrogens, it is metabolized slowly in the liver and so has a longer half-life.
The influence of hormonal contraception on depression and female sexuality: a narrative review of the literature
Published in Gynecological Endocrinology, 2022
Laura Buggio, Giussy Barbara, Federica Facchin, Laura Ghezzi, Dhouha Dridi, Paolo Vercellini
Estrogens regulate synapse formation in multiple brain regions, including the hippocampus, prefrontal cortex and primary sensory-motor cortex [43]. Four natural estrogens exist in humans: estrone (E1), estradiol (E2), estriol (E3), and estetrol (E4). E2 is the most biologically active of the natural estrogens and the primary estrogen of the reproductive years. E1, the primary estrogen of menopause, results primarily from the conversion of adrenal androstenedione by aromatase in peripheral fat. Ethinyl estradiol (EE), the form of synthetic estrogen used in combined hormonal contraceptives, undergoes hepatic conjugation following oral administration, but unlike estradiol, it remains highly potent. EE is more biologically active compared to E2 and cannot be converted in E1 or other weaker estrogens [44].
A technology evaluation of Annovera: a segesterone acetate and ethinyl estradiol vaginal ring used to prevent pregnancy for up to one year
Published in Expert Opinion on Drug Delivery, 2020
Elizabeth A. Micks, Jeffrey T. Jensen
Participants in the U.S. open-label Phase III trial were recruited at two sites for the Hepatic Factors Substudy [47]. Ethinyl estradiol is known to be a potent inducer of hepatic protein synthesis, including coagulation factors, which may be associated with the increased risk of VTE observed in users of combined hormonal contraceptives. Thrombotic biomarkers are often assessed in studies of hormonal contraceptives as indicators for VTE risk, but no studies have validated any biomarker as an actual surrogate for true VTE risk [48]. Over 13 cycles of use in 129 women enrolled in the sub-study, the SA/EE ring was associated with increased levels of SHBG, factor VIII, and fibrinogen, and decreased levels of protein S [47]. SHBG increased from 89.9 nmol/L at baseline to 187.2 nmol/L in cycle 13. In an analysis of only women switching from a different method of contraception containing EE (who had expected baseline elevations in hepatic proteins), only SHBG was noted to increase (mean increase of 28.4 nmol/L), and small declines in factor VIII and fibrinogen were noted with CVR use.
Sexuality in premature ovarian insufficiency
Published in Climacteric, 2019
R. E. Nappi, L. Cucinella, E. Martini, M. Rossi, L. Tiranini, S. Martella, D. Bosoni, C. Cassani
There is a knowledge gap in the management of sexual symptoms specifically in POI women (Table 1). The principle of avoiding androgen insufficiency induced by administration of exogenous hormones should guide clinical decisions71. Then, transdermal estradiol may be preferable over oral estrogen therapy because of less effect on sex hormone-binding globulin and free testosterone levels72 and modest improvement of sexual function in early postmenopausal women73. Similarly, the use of a natural estradiol-containing contraceptive pill should be preferred over ethinylestradiol. Even androgenicity of progestogens has some value74. Tibolone, a special form of HT with weak androgenic properties, was investigated in postmenopausal women with low desire and poor arousal, showing positive results75. Various local estrogen treatments are equally effective in reversing VVA/GSM symptoms, including dyspareunia and other associated sexual dysfunctions, alone or even combined with systemic HT. They have a good safety profile because low doses result in minimal systemic absorption64,76.
Related Knowledge Centers
- Estrogen
- Transdermal Patch
- Menopause
- Oral Contraceptive Pill
- Progestogen
- Signs & Symptoms
- Gynaecology
- Hormone-Sensitive Cancer
- Oral Administration
- Vaginal Ring